Request Items

Please tell us a bit about yourself. We will contact you for more information about the item(s) you are in need of.

Name (* required)

Phone (* required)

Email (* required)

County (* required)
---AdairAllenAndersonBallardBarrenBathBellBooneBourbonBoydBoyleBrackenBreathittBreckinridgeBullittButlerCaldwellCallowayCampbellCarlisleCarrollCarterCaseyChristianClarkClayClintonCrittendenCumberlandDaviessEdmonsonElliottEstillFayetteFlemingFloydFranklinFultonGallatinGarrardGrantGravesGraysonGreenGreenupHancockHardinHarlanHarrisonHartHendersonHenryHickmanHopkinsJacksonJeffersonJessamineJohnsonKentonKnottKnoxLarueLaurelLawrenceLeeLeslieLetcherLewisLincolnLivingstonLoganLyonMcCrackenMcCrearyMcLeanMadisonMagoffinMarionMarshallMartinMasonMeadeMenifeeMercerMetcalfeMonroeMontgomeryMorganMuhlenbergNelsonNicholasOhioOldhamOwenOwsleyPendletonPerryPikePowellPulaskiRobertsonRockcastleRowanRussellScottShelbySimpsonSpencerTaylorToddTriggTrimbleUnionWarrenWashingtonWayneWebsterWhitleyWolfeWoodford
How did you hear about us? (* required)

I am a... (* required)
---Individual with a DisabilityFamily Member, Guardian, Authorized RepresentativeRepresentative of EducationRepresentative of EmploymentRepresentative of Health, Allied Health, RehabilitationRepresentative of Community LivingRepresentative of TechnologyOther
Relationship to person using the item(s) (* required)
---SelfFamily MemberCaseworkerOther ProfessionalOther

Please describe the assistive technology and/or durable medical equipment item(s) you are in need of.